A new management strategy for renal angiomyolipomas: superselective arterial embolization in combination with radiofrequency ablation

Abstract

Background: The present study analyzed the safety and efficacy of superselective arterial embolization (SAE) combined with radiofrequency ablation (RFA) to treat renal angiomyolipoma (RAML).Methods: This retrospective study included the clinical data of 6 patients with RAML treated between March 2016 and October 2017. All patients underwent RFA treatment immediately after SAE guided by angio-computed tomography (angio-CT). The tumor size, renal function and complications, and time to recurrence were compared before and after treatment. Results:The success rate of the SAE + RFA technique was 100%, and no serious complications were found during or after surgery. After treatment, the patients' symptoms, including low back pain and hematuria, were relieved. The pre-treatment creatinine level (55.6±11.0 μmol/L) did not differ significantly from the post-treatment creatinine level (68.2±13.7 μmol/L), which was measured 1 day after surgery (t=1.75, P=0.109). The mean follow-up time was 29.5±6.1 months. By the end of the follow-up period, the maximum diameter of the tumor was 3.1±0.6 cm, which was significantly smaller than the pre-treatment diameter of 5.9±1.01 cm (t=5.83, P<0.001). At 3 months after surgery, the maximum diameter of the tumor was reduced by 22-38% in all 6 patients. At the last follow-up examination, the maximum diameter of the tumor was reduced by 36-61%. Contrast-enhanced CT or magnetic resonance imaging scans showed that the enhanced part of the original lesion had disappeared, the renal parenchyma was full of even fat signals, and only one patient had new enhanced lesions at the site of the original lesions.Conclusions: SAE combined with RFA is a safe and effective treatment for RAML, and its strengths qualify it to become a new treatment strategy for RAML.

The radiomics-clinical nomogram for predicting the response to initial superselective arterial embolization in renal angiomyolipoma, a preliminary study

“…The volume shrinkage in the cohort was significant and within the reported range of 27% to 55.1% ( 11 , 20 , 26 ). In the clinical model, tumor shrinkage rate was significantly related to angiomyogenic tissue ratio, which was consistent with previous studies ( 27 , 28 ). Hocquelet et al.…”

“…1% (11, 20, 26). In the clinical model, tumor shrinkage rate was significantly related to angiomyogenic tissue ratio, which was consistent with previous studies (27,28). Hocquelet et al (9) reported a significant difference in tumor volume reduction between RAMLs with less than 50% fat and those with more than 50% fat (84% vs. 50%; p < 0.00001).…”

“…The dysmorphic and immature vascular tissue present in RAMLs was prone to the formation and rupture of aneurysms ( 32 ). With the enlargement of the tumor, immature vascular components might induce intra-tumoral aneurysms and resulted in rupture ( 28 ). Whether in terms of improving embolization efficacy or preventing rupture, aneurysm was an important factor that required serious attention.…”

Advancements in the diagnosis and treatment of renal epithelioid angiomyolipoma: A narrative review

“…In addition, interventional therapy, including selective arterial embolization (SAE), ablation and SAE combined with ablation, has become an important treatment option, especially for patients with acute rupture with hemorrhage and those intolerant to surgery. Currently, it is believed that interventional therapy should be considered when the maximum diameter of renal AML is >4 cm or relevant clinical symptoms appear 44 . However, postoperative renal impairment, tumor recurrence, and retreatment after embolization remain urgent problems to be solved in clinical practice.…”

“…Currently, it is believed that interventional therapy should be considered when the maximum diameter of renal AML is >4 cm or relevant clinical symptoms appear. 44 However, postoperative renal impairment, tumor recurrence, and retreatment after embolization remain urgent problems to be solved in clinical practice. In this challenging context, standard chemotherapy regimens for soft tissue sarcomas have only been shown to be effective in a small subset of patients, and long-term results remain unsatisfactory.…”